What is Chronic Pain?
Chronic pain is defined as persistent pain that lasts longer than 3 to 6 months, or pain that persists after the initial tissue damage or injury has healed. It can also occur in the absence of any identifiable initial pathology or injury. Chronic pain is conceptualised in terms of the interaction among biological, behavioural, social, cognitive, emotional and environmental factors.
Effects of Chronic Pain
(i) Activity levels
Pain can lead to reduction in level of physical activity in some individuals. This temporary decrease in pain levels reinforce and maintain low levels of activity. Over time however, this underactivity can lead to physical deconditioning and lowered tolerance for activity and pain. On the other hand, some individuals may increase their activity level in order to maintain their functioning, leading to subsequent increases in pain and suffering from this overactivity.
(ii) Emotions
Pain often leads to emotional distress such as lowered mood, anxiousness and anger. However, emotional distress can also trigger, worsen or maintain pain. Literature estimates that about 40-50% of chronic pain patients meet diagnostic criteria for clinical depression.
Additionally, patients also tend to experience anxiety linked to worry over the nature or causes of their pain, potential progression and future quality of life. This anticipatory worries or fear towards pain may then lead to avoidant behaviours (e.g. reduction of participation in activities), and hence, restricted range of activities, functional limitations, and physical deconditioning. This harm-avoidance cycle worsens quality of life, mood, and functioning in the long-run.
Lastly, anger is also a common experience for chronic pain patients. For example, they may feel frustrated with medical professionals over the persistent pain despite receiving treatment. It was found that increases in pain severity tends to precede increases in anger, and inhibition of anger is linked to increased pain severity.
(iii) Cognitions
(iv) Physiological arousal
Negative cognitions and mood states (such as anxiety) may lead to increased physiological arousal and muscle tension and hence, increasing levels of pain.
(v) Social Interaction
Social interaction can affect pain behaviour and use of coping strategies. For example, responses from loved ones in terms of sympathy, criticisms, practical help or enabling behaviours can affect pain experiences.
(vi) Medication Overuse
Many different types of medications are used to treat chronic pain such as nonopioid analgesic medication, muscle relaxants, anticonvulsants, psychotropics and opioid medications.
The use of opioid medication is of concern, especially given the increasing number of patients being prescribed opiates for long-term basis, potential for misuse or abuse and decreasing effectiveness in managing pain with use over time.
Psychological treatment for Chronic Pain
There are various psychological approaches in the treatment for chronic pain such as Cognitive-Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and mindfulness.
Research has shown that compared to usual care, CBT showed small to medium effects on pain intensity, mood, and catastrophizing across a variety of pain conditions. Some of the techniques taught during CBT sessions include relaxation training, cognitive restructuring (e.g. adopting a positive mindset, improving self-efficacy) and behavioural activation (e.g. activity scheduling, problem-solving).
Learning these techniques can help patients better manage their pain and hence, reduce the negative impact on their daily lives.
If you have difficulties managing your chronic pain, it is encouraged that you seek help early.
